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Effectiveness of Counselling for

Asthmatic Children in Hospital Melaka

By Ng Wang SingHospital Melaka

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INTRODUCTION

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INTRODUCTION- Paediatric asthma is a major global health

problem (von Mutius 2000).- Asthma can impair the child’s ability to enjoy

and participate in activities and affect sleep patterns and academic (Lenney et al. 1994).

- A local study found 13.8% of primary school children in Kuala Lumpur to be asthmatic (CPG KKM - 2002).

- Many factors are involved in achieving good control of asthma.i) Non pharmacologicalii) Pharmacological

von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82(suppl II):ii2-ii5. Lenney W, Wils NEJ, O’Neill BA. The burden of paediatric asthma. Eur Respir Rev 1994;4:49-62.

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- Patient might need to carry out complex medication plans, initiate home environmental changes and monitor asthma symptoms.

- Patient education for asthma self-management is effective in improving asthma control (Gibbson et al. 2002).

- The role of pharmacists in patient education and evaluation of therapy is taking on more relevance everyday.

INTRODUCTIONINTRODUCTION

Gibson PG, Powell H, Coughlan J, Wilson AJ, Abramson M, Haywood P et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2002;CD001117.

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AIM & OBJECTIVES

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AIM & OBJECTIVES

AIMS

To study the effectiveness of counseling by Pharmacist on Asthmatic children.

OBJECTIVES- To determine the outcome of asthmatic children in terms of

improvement in symptoms - To determine the improvement of inhaler technique post

counselling sessions.

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METHODOLOGY

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METHODOLOGY

- This is a prospective analytical study from June 2006 – 31 October 2006 .

- Inclusion criteria: Children with stable and moderate asthmaAge of the patient: 1 to 15 years old

- Exclusion criteria:Children have illness other than asthmaNewly diagnosed asthmaPatients who refused to participate in this study

- An oral informed consent had been obtained from care givers.

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METHODOLOGY

Interventions: Modified Asthma Control Test (ACT) questionnaires was used to

measure the asthmatic control. Consists of 5 questions:

1. Limitation of physical activities due to asthma.2. Day time asthmatic symptoms3. Nocturnal cough4. Frequency of using nebulizer or bronchodilator5. Perception of parents towards the control of asthma of their children.

Scores on each item can range from 1 to 5 (1: maximum impairment & 5: no impairment).

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METHODOLOGY

At admission to the programme, the questionnaire was administered by caregivers.

The technique of using easyhaler of patients who were on easyhaler was assessed.

The child and caregivers received an explanatory booklet during counselling session.

The pharmacist and children with their parents scheduled a visit for 4 weeks and 8 weeks later.

For subsequent visit, same questionnaire was administered by caregiver and technique of using easyhaler was assessed.

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DEFINITION OF COUNSELING

1. Basic facts about asthma

2. Roles of Medications

3. Skills

4. Environmental control measure

5. When and How to take rescue action

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METHODOLOGY

Data analysis: The statistical analysis of data was done using

the Statistical Package for Social Sciences for Windows (SPSS) version 12.0.

Comparisons of asthmatic symptoms were made between pre-intervention status (baseline) and post-intervention status (4 weeks and 8 weeks).

Data was analyzed using McNemar test for repeated measures.

P values of 0.05 or less were considered statistical significant.

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ALGORITHM

Identify Asthmatic patients in clinicTake patient baseline information

(Questionnaire 1 given)

Counselling by Pharmacist

TCA first month (Questionnaire 2 given)

TCA second month(Questionnaire 3 given )

Continue follow-up

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RESULT

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CHARACTERISTICS OF PATIENTS

Gender of Patients23 (72%)

9 (28%)

Male Female

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CHARACTERISTICS OF PATIENTS

Races of Patient

3 (9%)

5 (16%)

24 (75%)

Malay Chinese Indian

Majority of patients are Malay, followed by the Indian and Chinese

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Types of Medications

1

1513

3

0

5

10

15

20

Nu

mb

er o

f p

ati

ent

Easyhaler MDI + aerochamberTypes of Inhaler

Beclomethasone + salbutamol + salmeterolBeclomethasone and salbutamolSalbutamol only

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RESULTS: CONTROL OF ASTHMA SYMPTOMS

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25

10

323232

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7

13

0

5

10

15

20

25

30

35

ACT 1 ACT 2 ACT 3

Asthma Control Test (ACT)

Nu

mb

er o

f P

ati

ents

Sample of Patient Good Control Poor Control

p=0.549 p=0.109

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RESULTS:TECHNIQUE OF USING EASYHALER

2

13

1

15

10

15

10

0

2

4

6

8

10

12

14

16

Nu

mb

er o

f p

ati

ent

Baseline Follow-up 1 Followup 2

Good Moderate Poor

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DISCUSSION

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DISCUSSION

Structured counselling by pharmacist can improve the asthmatic control of some patients.

Counselling may improve the awareness about asthma, inform them about medication and improve patients’ attitude.

Using medicines without being aware of fundamental facts about the treatment may lead to mistakes or non-compliance.

Regular and repeated guidance by pharmacists and physicians is important to be ensure patient is coping with treatment (Närhi et al. 2001).

Närhi U, Airaksinen M, Tanskanen P, Enlund H. The effects of a pharmacy-based intervention on the knowledge and attitudes of asthma patients. Patient Educ Couns 2001;43:171-177.

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DISCUSSION

The pharmacists identified any drug therapy problems.

The pharmacist gave recommendations about the correct use of inhalers and reinforced the indications of medicines.

The education and intervention seem to be important because patient and caregivers often ignore or fail to remember instruction given by physician.

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LIMITATIONS

Small convenience sample with no control group limits generalization and interpretation of the results.

Asthma control was reported by care givers but not patient themselves.

Selection bias

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CONCLUSION

Proper counseling helps to achieve good

control of disease in asthmatic children. It is useful in clarifying many myths and

mistaken concepts about drug therapy and disease.

THANK YOU